• Persons with high scores on psychiatric screening scales appear frequently in general medical settings, psychiatric outpatient clinics, and other agencies providing assistance, but there is considerable controversy concerning the appropriate interpretation of high scores on such scales obtained in community epidemiological studies. Data are presented from a 16-year follow-up study of children, first studied in 1961, examining developmental aspects of achieving high scores on such scales. Data come from the children themselves, their mothers, teachers, and school records. The findings are consistent with the hypothesis that such generalized distress reports are in part a learned pattern of illness behavior involving a focus on internal feeling states, careful monitoring of body sensations, and a high level of self-awareness.